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Achievement of benchmark outcomes by a young surgical attendant performing pancreatoduodenectomies

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Abstract

Purpose

Pancreatoduodenectomy is a challenging procedure for young general surgeons, and no benchmark outcomes are currently available for young surgeons who have independently performed pancreatoduodenectomies after completing resident training. This study aimed to identify the competency of a young surgeon in performing pancreatoduodenectomies, while ensuring patient safety, from the first case following certification by a General Surgical Board.

Methods

A retrospective review of data from the university hospital was performed to assess quality outcomes of a young surgical attendant who performed 150 open pancreatoduodenectomies between July 13, 2006, and July 13, 2020. Primary benchmark outcomes were hospital morbidity, mortality, postoperative pancreatic fistula, postoperative hospital stay, and disease-free survival.

Results

All benchmark outcomes were achieved by the young surgeon. The 90-day mortality rate was 2.7%, and one patient expired in the hospital (0.7% in-hospital mortality). The overall morbidity rate was 34.7%. Postoperative pancreatic fistula grades B and C were observed in 5.3% and 0% of patients, respectively. The median postoperative hospital stay was 14 days. The 1- and 3-year disease-free survival were 71.3% and 51.4%, respectively.

Conclusion

Pancreatoduodenectomy requires good standards of care as it is associated with high morbidity and mortality. As only one surgeon could be included in this study, our benchmark outcomes must be compared with those of other institutions.

Clinical trial registration

The study was registered at Thai Clinical Trials Registry and approved by the United Nations (registration identification TCTR20220714002).

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References

  1. Schnelldorfer T, Sarr MG (2009) Alessandro codivilla and the first pancreatoduodenectomy. Arch Surg 144:1179–1184. https://doi.org/10.1001/archsurg.2009.219

    Article  PubMed  Google Scholar 

  2. Whipple AO (1942) Present-day surgery of the pancreas. N Engl J Med 226:515–526. https://doi.org/10.1056/NEJM194203262261303

    Article  Google Scholar 

  3. Traverso LW, Longmire WP Jr (1980) Preservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation. Ann Surg 192:306–310. https://doi.org/10.1097/00000658-198009000-00005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Braasch JW, Rossi RL (1985) Pyloric preservation with the whipple procedure. Surg Clin North Am 65:263–271. https://doi.org/10.1016/s0039-6109(16)43581-4

    Article  CAS  PubMed  Google Scholar 

  5. Grace PA, Pitt HA, Tompkins RK, DenBesten L, Longmire WP Jr (1986) Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg 151:141–149. https://doi.org/10.1016/0002-9610(86)90024-3

    Article  CAS  PubMed  Google Scholar 

  6. Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137. https://doi.org/10.1056/NEJMsa012337

    Article  PubMed  Google Scholar 

  7. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127. https://doi.org/10.1056/NEJMsa035205

    Article  CAS  PubMed  Google Scholar 

  8. Cameron JL, Riall TS, Coleman J, Belcher KA (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15. https://doi.org/10.1097/01.sla.0000217673.04165.ea

    Article  PubMed  PubMed Central  Google Scholar 

  9. He J, Ahuja N, Makary MA et al (2014) 2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. HPB (Oxford) 16:83–90. https://doi.org/10.1111/hpb.12078

    Article  PubMed  Google Scholar 

  10. Greenblatt DY, Kelly KJ, Rajamanickam V et al (2011) Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 18:2126–2135. https://doi.org/10.1245/s10434-011-1594-6

    Article  PubMed  Google Scholar 

  11. Eeson G, Chang N, McGahan CE et al (2012) Determination of factors predictive of outcome for patients undergoing a pancreaticoduodenectomy of pancreatic head ductal adenocarcinomas. HPB (Oxford) 14:310–316. https://doi.org/10.1111/j.1477-2574.2012.00448.x

    Article  PubMed  Google Scholar 

  12. Faraj W, Alameddine R, Mukherji D et al (2013) Postoperative outcomes following pancreaticoduodenectomy: how should age affect clinical practice? World J Surg Oncol 11:131. https://doi.org/10.1186/1477-7819-11-131

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kimura W, Miyata H, Gotoh M et al (2014) A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy (japanese). Ann Surg 259:773–780. https://doi.org/10.1097/SLA.0000000000000263

    Article  PubMed  Google Scholar 

  14. Maruthappu M, El-Harasis MA, Nagendran M, Orgill DP, McCulloch P, Duclos A, Carty MJ (2014) Systematic review of methodological quality of individual performance measurement in surgery. Br J Surg 101:1491–8; discussion 1498. https://doi.org/10.1002/bjs.9642

  15. Sheetz KH, Nuliyalu U, Nathan H, Sonnenday CJ (2020) Association of surgeon case numbers of pancreaticoduodenectomies vs related procedures with patient outcomes to inform volume-based credentialing. JAMA Netw Open 3:e203850. https://doi.org/10.1001/jamanetworkopen.2020.3850

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13. https://doi.org/10.1016/j.surg.2005.05.001.10.1016/j.surg.2005.05.001

    Article  PubMed  Google Scholar 

  17. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  PubMed  Google Scholar 

  18. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768. https://doi.org/10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  19. Besselink MG, van Rijssen LB, Bassi C et al (2017) Definition and classification of chyle leak after pancreatic operation: a consensus statement by the international study group on pancreatic surgery. Surgery 161:365–372. https://doi.org/10.1016/j.surg.2016.06.058

    Article  PubMed  Google Scholar 

  20. National Healthcare Safety Network, Centers for Disease Control and Prevention (2017) Surgical site infection (SSI). http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed 25 January 2017

  21. Bilimoria KY, Bentrem DJ, Lillemoe KD, Talamonti MS, Ko CY, Pancreatic Cancer Quality Indicator Development Expert Panel, American College of Surgeons (2009) Assessment of pancreatic cancer care in the United States based on formally developed quality indicators. J Natl Cancer Inst 101:848-859. https://doi.org/10.1093/jnci/djp107

  22. Sabater L, García-Granero A, Escrig-Sos J, Gómez-Mateo Mdel C, Sastre J, Ferrández A, Ortega J (2014) Outcome quality standards in pancreatic oncologic surgery. Ann Surg Oncol 21:1138–1146. https://doi.org/10.1245/s10434-013-3451-2

    Article  PubMed  Google Scholar 

  23. Abbott DE, Martin G, Kooby DA et al (2016) Perception is reality: quality metrics in pancreas surgery - a central pancreas consortium (CPC) analysis of 1399 patients. HPB (Oxford) 18:462–469. https://doi.org/10.1016/j.hpb.2015.11.006

    Article  PubMed  Google Scholar 

  24. Bassi C, Balzano G, Zerbi A, Ramera M (2016) Pancreatic surgery in Italy. criteria to identify the hospital units and the tertiary referral centers entitled to perform it. Update Surg 68:117–122. https://doi.org/10.1007/s13304-016-0371-2

    Article  Google Scholar 

  25. Maharaj AD, Ioannou L, Croagh D et al (2019) Monitoring quality of care for patients with pancreatic cancer: a modified Delphi consensus. HPB (Oxford) 21:444–455. https://doi.org/10.1016/j.hpb.2018.08.016

    Article  PubMed  Google Scholar 

  26. Sánchez-Velázquez P, Muller X, Malleo G et al (2019) Benchmarks in pancreatic surgery: a novel tool for unbiased outcome comparisons. Ann Surg 270:211–218. https://doi.org/10.1097/SLA.0000000000003223

    Article  PubMed  Google Scholar 

  27. Clavien PA, Barkun J, de Oliveira ML et al (2009) The clavien-dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  28. Cameron JL, He J (2015) Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg 220:530–536. https://doi.org/10.1016/j.jamcollsurg.2014.12.031

    Article  PubMed  Google Scholar 

  29. Ou C, Rektorysova M, Othman B, Windsor JA, Pandanaboyana S, Loveday BPT (2021) Benchmarking performance in pancreatic surgery: a systematic review of published quality metrics. J Gastrointest Surg 25:834–842. https://doi.org/10.1007/s11605-020-04827-9

    Article  PubMed  Google Scholar 

  30. Fitzgerald TL, Seymore NM, Kachare SD, Zervos EE, Wong JH (2013) Measuring the impact of multidisciplinary care on quality for pancreatic surgery: transition to a focused, very high-volume program. Am Surg 79:775–780. https://doi.org/10.1177/000313481307900817

    Article  PubMed  Google Scholar 

  31. van Rijssen LB, van der Geest LGM, Bollen TL et al (2016) National compliance to an evidence-based multidisciplinary guideline on pancreatic and periampullary carcinoma. Pancreatology 16:133–137. https://doi.org/10.1016/j.pan.2015.10.002

    Article  PubMed  Google Scholar 

  32. Müller PC, Kuemmerli C, Cizmic A et al (2022) Learning curves in open, laparoscopic, and robotic pancreatic surgery: a systematic review and proposal of a standardization. Ann Surg Open 3:e111. https://doi.org/10.1097/AS9.0000000000000111

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank our colleagues (staff, residents, and nurses) who trusted and provided great opportunities for our young surgeon to perform this difficult procedure. We thank Nannapat Pruphetkaew for her contribution in statistical data analysis.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Prince of Songkla University, 15 Kanjanawanich Road, Hat Yai, 90110, Songkhla, Thailand

    Sakchai Ruangsin, Somkiat Sunpaweravong & Supparerk Laohawiriyakamol

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  1. Sakchai Ruangsin
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  2. Somkiat Sunpaweravong
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Contributions

Sakchai Ruangsin, Somkiat Sunpaweravong, Supparerk Laohawiriyakamol participated in the study conception and design, drafting of the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Sakchai Ruangsin.

Ethics declarations

This study was approved by the Faculty of Medicine medical ethical committees (REC.63–338-10–1).

Statement of informed consent

The requirement for informed consent was waived due to the retrospective nature of the study.

Statement of human and animal rights

This study was approved by the Faculty of Medicine medical ethical committees (REC.63–338-10–1).

Consensus statement on submission and publication of manuscripts

The study was not a duplicate of fraudulent submission, and this manuscript has not been submitted elsewhere/is not under consideration by another journal.

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The authors declare no competing interests.

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Ruangsin, S., Sunpaweravong, S. & Laohawiriyakamol, S. Achievement of benchmark outcomes by a young surgical attendant performing pancreatoduodenectomies. Langenbecks Arch Surg 408, 404 (2023). https://doi.org/10.1007/s00423-023-03132-8

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